• Antibiotic resistance
• canaliculitis
• canaliculolith
• infection
• microbiology

Several approaches have been investigated for preventing myopia progression in children and teenagers. Among them, topical atropine has shown promising results and it is being adopted in clinical practice more and more frequently. However, the optimal formulation and treatment algorithm are still to be determined. We discuss the pharmacokinetic, pharmacodynamic, clinical, and tolerability profile revealed first by the multicenter, randomized ATOM 1 and 2 trials and, more recently, by the LAMP Study. Results from these trials confirmed the efficacy of low-concentration atropine with a concentration-dependent response. Although atropine at 0.025% and 0.05% concentrations has shown the most encouraging results in large-scale studies, these formulations are not yet commonplace in worldwide clinical practice. Moreover, their rebound effect and the possibility of reaching a stabilization effect have not been fully investigated with real-life studies. Thus, further larger-scale studies should better characterize the clinical efficacy of atropine over longer follow-up periods, in order to define the optimal dosage and treatment regimen.

To report the clinical and microbiological features of Acanthamoeba keratitis (AK) related to contact lens use in a tertiary hospital in China.

In this retrospective study, the medical results of 61 cases of AK related to contact lens use from January 2000 to December 2017 were reviewed. The data included patients’ demographics, lens type, history, risk factors, disease stages, corneal scraping and culture reports, and treatments. Moreover, genotypic identification of some of the isolates was carried out with a PCR assay and sequence analysis of the 18S ribosomal DNA gene.

There were 64 eyes included in the study. A total of 32.8% of the patients wore soft contact lenses, and 67.2% of patients used overnight orthokeratology. In the cases (20 eyes) in the early stage, 65% (13 eyes) had positive results according to Giemsa-stained smears, and 0.9% sodium chloride (NaCl) wet mounts revealed trophozoites in 7 eyes (35%). Six eyes (30%) were diagnosed by confocal microscopy combined with clinical signs. In the orthokeratology patients, 87.8% (36/41) rinsed their lenses and/or cases with tap water; 55% of soft-lens wearers wore their lenses while showering. The genotype of 9 isolates was determined, and all the strains belonged to genotype T4. In the orthokeratology group, the number of patients who required therapeutic penetrating keratoplasty after 2005 was less than that before 2005 (chi-square test, χ² = 4.209, P = 0.04).

More than two-thirds of the cases were associated with orthokeratology. Examinations with Giemsa-stained smears, 0.9% NaCl wet mounts and confocal microscopy should be performed for patients who are highly suspected of having early-stage AK to help with early diagnosis. In the orthokeratology group, the rate of therapeutic keratoplasty after 2005 was less than that before 2005.

The online version of this article (10.1186/s12886-019-1210-2) contains supplementary material, which is available to authorized users.

• Acanthamoeba keratitis
• Contact lens
• Genotype

The aim of this study was to investigate the effect of overnight orthokeratology (OOK) on ocular surface and meibomian gland dysfunction in teenagers with myopia.

A total of 59 subjects were recruited in this prospective study. The following tests were performed before and after 1, 3, 6, 12, and 24 months of OOK lens wear, including ocular surface disease index (OSDI) questionnaire, slit-lamp examination, and Keratograph 5M.

No infectious keratitis occurred during the study. OSDI scores increased gradually and reached the maximum at 6 months of OOK wear (P < 0.001). The meniscus height was significantly increased at 1 and 3 months after the initiation of OOK (P=0.006, P=0.035). The corneal fluorescein staining at 1, 3, 6, 12, and 24 months after wearing OOK were all increased than the prewearing level with significant difference (P=0.014, P=0.036, P < 0.001, P < 0.001, and P=0.008, respectively). The first and the average tear film NIKBUT were all higher than the prewearing level, but there was no significant difference between every follow-up time points (P > 0.05). The lid margin abnormalities were significantly increased (P=0.003, P=0.038, and P=0.015) at 6, 12, and 24 months after the initiation of OOK. There was no significant difference in the meibomian gland orifice scores at each follow-up time points compared to the prewearing level (P > 0.05). The meibomian gland lipid secretion scores after wearing OOK were higher than those of the prewearing level, however, without statistically significant difference (P > 0.05). No significant differences of the degree of difficulty of lipid excretions were detected after the initiation of OOK (P > 0.05). There was no significant difference in meibomian gland dropout scores between all follow-up time points and the prewearing level (P=1.000).

OOK increased the symptoms of dry eye and decreased the function of tear film by affecting the meniscus height and BUT. OOK did not affect the function of meibomian glands.Clinical Study registration number: ChiCTR18000185708.

• ATOM
• atropine
• myopia
• myopia prevention
• orthokeratology
• spectacles

• Acanthamoeba keratitis
• Care systems
• Contact lens
• Corneal infection
• Scleral lens

• Complications
• Contact lens
• Infectious keratitis
• Myopia
• Orthokeratology

• atropine
• bifocal spectacles
• myopia
• orthokeratology
• progression
• progressive additional lens spectacles
• soft bifocal contact lenses

The purpose of this study is to report a case of Providencia stuartii conjunctivitis.

This study is a retrospective chart review of a patient with persistent conjunctivitis.

We report the first case of P. stuartii conjunctivitis. Our patient was an elderly man living in a nursing home who was likely immunocompromised from longstanding diabetes mellitus. A conjunctival swab culture was able to identify the infecting bacteria and its antibiotic susceptibility. The conjunctivitis was successfully treated with vancomycin drops and oral sulfamethoxazole and trimethoprim.

P. stuartii is an increasingly common bacterium found in the urine of immunocompromised nursing home residents with indwelling Foley catheters. While it has rarely been found to cause ocular infections, P. stuartii may be suspected in elderly, immunocompromised nursing home residents.

• Bacterial
• Conjunctivitis
• Providencia stuartii
• Rare

• Acanthamoeba Keratitis/diagnosis
• Acanthamoeba Keratitis/drug therapy
• Acanthamoeba Keratitis/parasitology
• Adolescent
• Anti-Bacterial Agents/therapeutic use
• Antiprotozoal Agents/therapeutic use
• Child
• Contact Lenses/adverse effects
• Corneal Ulcer/diagnosis
• Corneal Ulcer/drug therapy
• Corneal Ulcer/microbiology
• Eye Infections, Bacterial/diagnosis
• Eye Infections, Bacterial/drug therapy
• Eye Infections, Bacterial/microbiology
• Eye Infections, Parasitic/diagnosis
• Eye Infections, Parasitic/drug therapy
• Eye Infections, Parasitic/parasitology
• Female
• Hong Kong
• Hospitals, Special
• Humans
• Male
• Ophthalmology
• Orthokeratologic Procedures/adverse effects
• Retrospective Studies
• Tertiary Healthcare
• Young Adult

Orthokeratology is a reversible technique that temporarily changes the curvature of the cornea with the aim of addressing refractive errors. The United States Food and Drug Administration (FDA) granted approval for using reverse geometry contact lenses to correct myopia without any age restriction. Information from the pre-market applications to the FDA was rated as level II evidence. Another unapproved use of overnight orthokeratology is for the prevention of myopic progression. Although orthokeratology is advocated to reduce myopic progression, there are limited long-term studies with substantial evidence of its benefits. Much of this evidence comes from non-robust experimental studies using historical or self-selected controls with relative high dropout rates. Although some positive results have been published in temporarily reducing the myopic refractive error and its progression, the use of these lenses can be associated with serious complications such as microbial keratitis. Microbial keratitis is a potentially vision-threatening adverse response associated with contact lens wear. In fact, contact lens wear has been shown to be the predominant risk factor of microbial keratitis in some developed countries. Most of the published cases on overnight orthokeratology related microbial keratitis occurred in children or adolescents. Parents considering orthokeratology must make an informed decision about its temporary benefit and its potential for permanent loss of vision. The ophthalmic community should be reminded of the potential complications of orthokeratology.

• Orthokeratology
• Infections
• Microbial keratitis
• Cornea
• Corneal ulcer
• Contact lens
• Myopia

A patient presented with a corneal foreign body in his only eye. He was treated with prophylactic antibiotics and sent home, but deteriorated.

He returned to the hospital 5 days later, and on slit-lamp examination, there was ciliary injection, corneal oedema and a 1 mm × 1 mm corneal abscess with mild anterior uveitis. Corneal scrapings were taken for culture on a non-nutrient agar with a lawn of Escherichia coli, on chocolate agar and on blood agar. He was treated with fortified gentamicin and cefazolin drops. He improved and was discharged 4 days after admission. On day 5, the culture results showed acanthamoeba. He was brought back to the hospital and treated with hourly chlorhexidine drops, ofloxacin six times daily and neomycin/dexamethasone drops once daily. On day 7, he was discharged to continue treatment at home, at which time his visual acuity in that eye was 6/9, and slit-lamp examination showed punctate keratitis and a stromal opacity with mild peripheral infiltration.

Culture on non-nutrient agar with a lawn of E. coli is a rapid, reliable and less invasive alternative to corneal biopsy for the diagnosis of acanthamoeba infection. We suggest using this method where acanthamoeba is suspected. Owing to the risk of corneal abscess, orthokeratology should be avoided in an amblyopic patient or an only eye. Acanthamoeba infection may be masked by other eye diseases.

• Anterior Eye Segment/pathology
• Contact Lenses/adverse effects
• Humans
• Keratitis/etiology
• Keratitis/pathology
• Microscopy, Confocal

• Acanthamoeba/drug effects
• Acanthamoeba/pathogenicity
• Amebiasis/drug therapy
• Animals
• Contact Lenses, Extended-Wear/adverse effects
• Contact Lenses, Extended-Wear/microbiology
• Eye Infections, Bacterial/drug therapy
• Eye Infections, Bacterial/microbiology
• Eye Infections, Fungal/drug therapy
• Eye Infections, Fungal/physiopathology
• Eye Infections, Viral/physiopathology
• Eye Infections, Viral/virology
• Female
• Humans
• Keratitis/drug therapy
• Keratitis/microbiology
• Keratitis/parasitology
• Keratitis/virology
• Male

• Acanthamoeba Keratitis/drug therapy
• Acanthamoeba Keratitis/etiology
• Acanthamoeba Keratitis/pathology
• Acanthamoeba Keratitis/physiopathology
• Adolescent
• Anti-Infective Agents, Local/therapeutic use
• Biguanides/therapeutic use
• Chlorhexidine/therapeutic use
• Circadian Rhythm
• Contact Lenses/adverse effects
• Drug Therapy, Combination
• Female
• Humans
• Male
• Visual Acuity

• Anti-Infective Agents/pharmacology
• Candida albicans/drug effects
• Candida albicans/isolation & purification
• Contact Lens Solutions/pharmacology
• Contact Lenses/microbiology
• Disinfection/methods
• Drug Storage
• Equipment Design
• Escherichia coli/drug effects
• Escherichia coli/isolation & purification
• Fusarium/drug effects
• Fusarium/isolation & purification
• Humans
• Humidity/adverse effects
• Pseudomonas aeruginosa/drug effects
• Pseudomonas aeruginosa/isolation & purification
• Serratia marcescens/drug effects
• Serratia marcescens/isolation & purification
• Staphylococcus aureus/drug effects
• Staphylococcus aureus/isolation & purification
• Sunlight/adverse effects
• Temperature
• Time Factors

• Contact Lenses, Hydrophilic
• Cornea/pathology
• Cornea/physiopathology
• Corneal Topography
• Humans
• Myopia/pathology
• Myopia/therapy
• Quality of Life
• Refraction, Ocular
• Treatment Outcome